Joining the Network: How Doctors Become Part of In-Network Health Insurance
Most health insurance policyholders believe their network health insurance plans promise an exclusive set of providers. However, it is only essential to discuss who network doctors are.
Health Net Providers
In simple terms, any medical professional or doctor representing your insurance company’s network of healthcare providers is a network doctor. There are many insurance providers available both online and offline that establish provider networks from which you can avail healthcare as a customer (policyholder).
These networks typically feature doctors, laboratories, clinics, hospitals, and specialists. It’s necessary to mention that medical service providers are carefully inspected before they are added to an insurance company’s network. They agree to a legal contract when they join any insurance company’s network. This contract demands that doctors provide services at a specific rate to the insurer’s patients.
Network Health Insurance Plans
If you are a novice in this subject, you must note that the claim process for network providers strictly depends on your health insurance policy. Therefore, it is essential to go through your policy documents to verify if you qualify for network doctor treatment. You can even choose to consult with your healthcare executive.
Starting from the top, network doctors represent the insurance company’s direct billing network. Therefore, it will promise you cashless treatment. You must ideally present your network health insurance card to the responsible authority, and they will look after the payment. This exempts you from filing for a claim!
Alternatively, your claims process might take a different route if your medical attendant is not part of a direct billing network. Simply put, this will vary greatly depending on your insurance company contracts.
How Do Medical Professionals Join the Medical Insurance In-Network?
- You must submit the online request for participation form with a reputed network healthinsurance company.
- The insurance company personnel will immediately look into the current need to service their membership in your area. They will ensure that you get feedback from their end within 45 days regarding your qualification status. They will confirm whether you’re eligible for participation and begin contracting.
- Once you have received the approval from the insurance company, they will get your credentialing application from the Council for Affordable Quality Healthcare to begin the credentialing process.
- Your contract will be finalised once you finish the credentialing process.
- Ready to get started? You must pick the category that suits your skill set.Then, to fulfil your request, follow the directions.
What Happens If I Seek Treatment Outside of My Network? You will have to miss out on the discounted rates your network health insurance company promises if you opt for external care. And the parts of your plan that help control your costs may not work the same.
Conclusion
Network doctors will vary depending on your insurance policy and premiums. Therefore, you will understand better if you can discuss your doubts with your health insurance network professional or a third-party council.
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